In an individualised longer MDR-TB regimen, linezolid is included as a Group A drug. The adverse effect profile that most limits its prolonged use in TB therapy is:

• A Nephrotoxicity and electrolyte wasting
• B Peripheral and optic neuropathy with myelosuppression from mitochondrial toxicity ✓
• C Severe hepatotoxicity requiring routine discontinuation
• D Tendon rupture and cartilage damage

Explanation

Linezolid inhibits bacterial 23S ribosomal RNA but also impairs mitochondrial protein synthesis, producing time- and dose-dependent bone marrow suppression, peripheral neuropathy, optic neuritis and lactic acidosis. These effects are frequent with the prolonged courses needed for TB, so low-dose linezolid (600 mg or less daily) is now preferred. Tendon rupture is a fluoroquinolone effect and nephrotoxicity is typical of aminoglycosides.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

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